OBJECTIVES

: The expensive drug list is a derogation measure to the DRG hospital reimbursement system to finance all the drugs included on the positive list “liste en sus” (LES). The main purpose of the study was to describe the drug type and their reimbursement covered by the national health insurance.

METHODS

: All the drugs included in the LES list were extracted from the french claims database detailing reimbursement at the national level (FICHCOMP) between 2016 and 2018. Patient characteristics, geographic repartition, and treatment classification were described.

RESULTS

: In 2018, the NHI reimbursed 3,6 billion euros (63% for oncology vs 37% for non-oncology) for 562 million prescriptions delivered (51% for non-oncology vs 49% for oncology) in France. Among the non-oncology drugs, the most frequent drugs reimbursed were for immunologic disease (52%) followed by rare disease (24%), coagulation factor (10%), neurology (7%), anti-infectious (6,5%). Drug for chronic conditions such as cardiology, diabetes, ophthalmology, others were rarely reimbursed (< 1%). The mean age of the 310,774 patients who received at least one expensive drug in 2018 was 60 ± 18 years and 54% were females. Of all the reimbursed drugs, 83% came from public hospital. However, the proportion of oncologic drugs reimbursed was 58% in public hospital vs 85% for private sector. In terms of hospital concentration, 80% of all drugs and 80% of oncologic drug were reimbursed by < 200 hospitals and < 100 of 941 participants hospitals, respectively. Compared to 2017, reimbursement increased for all drugs by 1%, mostly driven by the increase of oncology drugs (+8%) and decrease on non-oncology (-8%).

CONCLUSIONS

: The reimbursement of LES are mainly driven by oncology drugs and mostly reimbursed by the public sector.